Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation dose would you use to treat a symptomatic osseous lesion secondary to AL-amyloidosis?
Extrapolating from our tracheobronchial experience, we’ve used 20 Gy in 10 fractions to target the underlying plasma cells that produce amyloid production. We’ve also used this regimen for ocular and GU (ureteric and bladder) amyloidosis. If there are obstructive or symptomatic lesions, then surgica...
How long do you wait to start adjuvant radiation after prostatectomy?
Generally, I will wait until the patient has recovered urinary continence before beginning adjuvant RT. In most cases, that will occur by about 3 months, but I have had patients in which I have waited as long as 12 months before beginning adjuvant RT because continence was slow to recover. In cases ...
When using oral contrast for simulation, how much prior to simulation do you have patients drink the contrast?
There are primarily three situations in which I might use oral contrast. The first is when treating an esophageal cancer, in which case we give the patient a small amount of contrast in the simulator and then have them drink some more just seconds before the scan. The second situation is when one wa...
How would you manage a patient with early-stage invasive ductal carcinoma with associated low-grade DCIS who was found to have ADH at the tumor margin on post-op pathology?
Presume it is focal and not diffuse involvement by AFH, I would get pre RT mammogram and if no residual calcification or abnormality, would proceed with RT.
How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?
The role of RT in MM is palliative in nature, and the focus should be on symptomatic improvement while minimizing marrow toxicity.Rad Oncs, as a whole, should not generally be using solid tumor palliative doses (such as 3 Gy x 10) routinely in MM as that ablates the marrow in that area without hope ...
How likely is late radiation induced lumbosacral plexopathy from treatment of anal cancer with chemo-RT 20 years ago and how would you manage it?
It's difficult to say "how likely" since we don't really have good long-term reporting for this specific late complication. I would say it's rare, but certainly possible. Late lumbosacral plexopathy has been reported as far out as 36 years from pelvic RT (Krkoska et al., PMID 36510189).In general, t...
What is your preferred approach in a patient unable to fill their bladder during prostate radiotherapy?
If a patient is willing to do a penile clamp or foley, then sure, go for it. Some patients want to 'do everything' and either is reasonable. Whether or not they need to is another question. Most Grade 3+ GU toxicity is either hemorrhage or stricture. Unfortunately, there isn't great data for any con...
Is 10 Gy x 5 an acceptable dose to use for lung SBRT in tumors with favorable location (eg. not central and not encroaching on the chest wall?)
The paper cited, which my colleague Kevin Stephans authored, used our large institutional data base with long term follow up to carry out a retrospective review of BED adjusted SBRT schedules and showed no difference in overall survival, but slightly improved local control, with higher BED schedules...
How do you counsel patients with Stage IIIA EGFR+ lung cancer regarding treatment intent with concurrent chemoRT + consolidative systemic therapy?
I think one of the crucial take-home points from the LAURA clinical trial (Lu et al., PMID 38828946) is how often we (the medical oncology community) tell patients we are treating them with "curative intent" but ignore the incredibly high relapse risk among patients with EGFR mutant NSCLC with stage...
How do you approach conventionally fractionated radiotherapy for treatment of an acoustic neuroma?
With 12 Gy single-fraction radiosurgery producing excellent tumor control, low complication rate, and good hearing preservation, we have rarely been using conventional fractionated radiotherapy for acoustic neuroma. If one uses conventional fractionated radiotherapy, the PTV margins will depend on t...